UK SAGE (September 2020) published the role of ventilation in controlling transmission of COVID-19, noting its importance, especially during winter. With regards to ventilation the RCA report noted that ventilation should be considered as a control measure in care homes. Recommendations, based on findings at four registered services, were therefore made around specialist IPC support for care homes for built environment issues and risk assessment coupled with risk assessment around consideration of fire and falls in context of the built environment to ensure no unintended consequences. As a result, the RCA highlighted the importance of understanding local context and the need to adapt the built environment in a risk based and proportionate way. Staff therefore needed to balance the harms of infection with the need to keep an individual's environment familiar to them as well as support residents who 'walked with purpose'. Many care homes accommodate frail, older residents, some with additional and increasingly complex needs, including those living with dementia and. Additionally, challenges around design, ergonomics, communal spaces, corridor width and shared shower and bathing facilities, together with the complex nature of the residents' conditions, made the provision of effective isolation challenging. ![]() As a result, the extent to which homes were able to fully incorporate guidance in relation to social distancing, PPE storage and availability, separation/ isolation and staff cohorting was variable and dependent on the design of the home. The RCA found that environmental factors were an important consideration in the ability of homes to limit disease transmission. Maintenance of clean and hygienic areas wit in the built environment in adult care homes is essential in the prevention of the spread of infectious diseases.
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